King's Fund report says NHS could get worse from 2013

'This is one of a number of recent studies pointing to the link between quality of patient care and the level of savings required in the NHS.

'Every single NHS Trust Board is acutely aware of the risk and is doing everything they can to manage it. All the evidence shows that they are currently doing a good job of either improving or maintaining patient care whilst realising significant savings.

'The real question is what support Trust Boards need as this task becomes more challenging over the next three years. Trust Chairs and Chief Executives consistently point to five strategic areas:

1. Long term stability in commissioning relationships to enable sensible financial planning.

2. Active support in delivering potentially unpopular service reconfiguration plans.

3. An NHS tariff that accurately reflects the full cost of the procedures undertaken and avoids unfairly penalising Trusts - for example on emergency readmissions.

4. Support in getting greater value from the pay bill that makes up 65% of the average Trust’s costs.

5. National support to help resolve the very small number of cases where a PFI contract is clearly financially unsustainable.

'All this needs to be underpinned by the clear understanding that Trust Boards are managing the biggest risk in the NHS by far and that they need support from the rest of the NHS to perform this task satisfactorily.'